Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Chapter 5 - Personal Care Services
Rule 23-223-5.3 - Covered Services
Universal Citation: MS Code of Rules 23-223-5.3
Current through September 24, 2024
A. The Division of Medicaid covers medically necessary personal care services (PCS) only for early and periodic screening, diagnosis and treatment (EPSDT)-eligible beneficiaries when:
1. Ordered and directed by the
beneficiary's primary physician or appropriate physician specialist.
2. Prior authorized by the Division of
Medicaid or designee.
3. The
required service(s) exceed the level of services provided through the home
health benefit.
4. Provided in a
setting in which the beneficiary's normal life activities take place.
5. All medical and home environment criteria
are met.
6. Are directly related to
the beneficiary's illness or disability.
7. Services can be safely provided by only
one (1) Certified Nursing Assistant (CNA) and do not require the assistance of
a second (2nd) CNA.
8. The beneficiary:
a) Is medically stable to receive PCS managed
safely in a non-institutional setting where normal life activities take
place,
b) Has a documented illness
or disability that requires the assistance of a CNA in order to safely perform
activities of daily living, and
c)
Requires more individual and continuous care than is available from a visiting
CNA through intermittent home health care.
9. The home environment is conducive to
appropriate growth and development for the beneficiary's age group and be
conducive to the provision of appropriate medical care.
10. There must be at least one (1) parent or
other caregiver capable of and willing to be trained to assist in the provision
of care for the beneficiary and the parent or caregiver must:
a) Provide evidence of parental or family
involvement and an appropriate home situation including, but not limited to, a
physical environment and geographic location for the beneficiary's medical
safety.
b) Have a reasonable plan
for an emergency situation including, but not limited to:
1) Power and equipment backup for equipment
necessary to the medical care of the beneficiary,
2) Access to a working telephone,
and
3) Available transportation
adequate to safely transport the beneficiary.
c) Comply with the plan of care, physician
office appointments and/or other ancillary services.
B. The level of care required to meet the beneficiary's needs is determined by the referring physician.
C. PCS services are covered only when provided:
1. By a CNA:
a) With a current Mississippi
certification,
b) Employed by a
private duty nursing (PDN) provider that is approved by the Division of
Medicaid to provide CNAs, and
c)
Have at least one (1) year of experience providing the type of care required by
the beneficiary's medical condition.
2. Under the supervision of an RN and at the
direction of the beneficiary's physician, and
3. In a non-institutional setting where
normal life activities take place.
D. PCS are covered:
1. On short-term basis for beneficiaries in
need of parent and/or caregiver training in order to reside in the home and
community, or
2. On a long-term
basis for beneficiaries that require substantial and complex care that exceeds
the level of service available from the home health benefit in order to remain
in the home and community setting.
42 C.F.R. § 440.167; Miss. Code Ann. §§ 43-13-117, 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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